HomeMy WebLinkAbout312869 06/26/17 94+d Cqq*F
CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH TMRVK AMOUNT: $*******235.00*
? 4 CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 312869
+,, CHICAGO IL 60677-7001 CHECK DATE: 06/26/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 484749 188.00 MEDICAL FEES
1125 4340700 484749 47.00 MEDICAL FEES
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by
whom rates per day, number of hours rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
355031 Community Occupational Health Services Terms
7169 Solution Center
Chicago, IL 60677-7001
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
3/15/17 484749 Pre-Employment Drug Testing XX5501 $ 47.00
3/15/17 484749 Pre-Employment Drug Testing XX5501 $ 188.00
Total—hF77 235.00
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer
Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341 4
FEIN: 35-1955223 R *` � � p� D
JUN 2 1 2011
BY:
Invoice
March 15, 2017
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Cannel Clay Parks & Recreation 03/17
1411 E. 116th St.
Cannel, IN 46032-
Invoice# 484749
Proc Code ICD Date Description Qty Charge Receipt Adjust Balance
746404 03/10/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Margaret Anderson Balance Due: 47.00
746404 1) 03/07/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
576.01 1
2)
S76.012A
Craig A Banning Balance Due: 47.00
746404 03/01/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Jaime B Follstad Balance Due: 47.00
746404 03/14/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Swati Jain Balance Due: 47.00
746404 03/14/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Michael C Wiegmann Balance Due: 47.00
Invoice# 484749 Balance Due: 235.00
Please remit payment promptly
PAST DISE
Cut and return with payment